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Re: Episiotomy and anal incontinenceFrom: ainsron@msn.comFri Jan 7 14:44:56 2000
At Fri, 07 Jan 2000, Bernard Cristalli wrote: > >Agreed for the risk associated with epis and that epis don't avoid severe >lacerations but... >it is a retrospective study, so in this population epis have been done when >the baby was big, when the situation was thought to lead to a laceration. That is my position on the argument about episiotomy. Those of us who don't do "routine" episiotomies will generally cut one if it is a large baby, in order to avoid/correct a shoulder dystocia. I will also cut one if I am doing an instrumental delivery and there is limited time for "stretching of the perineum" or if there appears to be an impending laceration and I want to avoid an irregular, jagged laceration. Until someone does a double blinded prospective study (which will never be done), it is all personal opinion and anecdote, not science, no matter how many literature reviews of retrospective studies and meta-analyses anyone performs. Having a baby vaginally w or w/o forceps, w or w/o vacuum, w or w/o episiotomy has to cause disruption of the pelvic floors nerves, ligaments and muscles. Just like any other neuro/muscular injury, in some people it will heal without evidence of long term disability, in others it will cause significant problems. When you find any way of predicting or preventing it, patent it, you will make a fortune. If you think that doing no episiotomies is the answer, good luck!!
-- Ronald E. Ainsworth, MD
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